Budget improves Oregon's home care system

The department's 2003-2005 budget includes funds for the first-ever labor contract with home care workers, an important improvement in the system that provides care to thousands of seniors and people with disabilities.

The budget provides $25 million for the contract, which covers about 13,000 client-employed providers who help with dressing, bathing, housekeeping and other daily activities. These services help seniors and people with disabilities remain in their homes. Oregonians set the foundation for improvements to the home-care system with approval in 2000 of Measure 99, which created the Oregon Home Care Commission. The commission was charged with:

Developing standards and training opportunities for home care workers

Establishing a registry of home care workers

Serving as "employer of record" for purposes of collective bargaining

Improving home care workers' benefits.

In 2001, home care workers organized under Local 99 of SEIU Local 503, the Oregon Public Employees Union.

HB 5030 contains about $25 million to fund the contract with home care workers.

The commission and union, with assistance from the state Department of Administrative Services, ratified an agreement on Aug. 1, 2003.

The agreement covers wages, future health coverage, future workers' compensation coverage, and leave benefits for all home care workers in the bargaining unit.

Home care workers will see a 40-cent-per-hour wage increase, effective July 1, 2003.

The agreement also calls for paid time off — one day per year for workers who work 80 hours in any month, and 24 hours per month for 24-hour, live-in workers.

Beginning April 1, 2004, home care workers will be eligible for health care coverage, which will start 30 days after they have worked a minimum of 88 hours in two preceding months, and for workers' compensation coverage. The agreement also has provisions for suspension or discharge, grievances, health and safety matters, mileage reimbursement, union rights and other matters. No strikes or lockouts are allowed.

For more information, contact Genevieve Sundet, with the department's Seniors and People with Disabilities group, by phone at (503) 945-5990, or by email.

Health Plan Standard enrollment declines

Nearly 55,000 Oregon adults were enrolled in the Oregon Health Plan's Standard benefit package in September 2003, a number that has fallen in recent months for several reasons.

Enrollment, once as high as 100,000, has dropped largely as a result of changing premium requirements that were effective Feb. 1, 2003. Beginning on that date, payments were required monthly. Previously, enrollees could delay paying premiums until the end of their six-month eligibility period, when full payment was required for re-enrollment.

The new premium rules, along with other changes in the benefit package, are part of an effort to operate the Health Plan in ways that parallel commercial health plans. About 35,000 people were disqualified from the Health Plan during the first months of required monthly premiums, through Aug. 1.

Other factors in declining enrollment included people deciding not to re-enroll in the Health Plan at the end of their eligibility period and people not applying in the first place, perhaps as a result of publicity about reduced benefits.

Monthly premiums range from $6 to $20.

The legislature has directed the department to take a look at the premium requirements and other policies to assess their impact on clients. A report will be made in late 2004.

Maintaining a safety net of services for seniors and people with disabilities

The 2003 Legislature sought to restore a safety net of services for the most vulnerable of Oregon's seniors and people with disabilities.

Clients receiving in-home and 24-hour services are classified in 17 levels depending on their ability to perform daily activities, with those in the lowest levels requiring the most assistance.

The 2003-2005 budget continues long-term care services for people in levels 1 through 11. Subject to federal approval, the budget also restores funding for services to people in levels 12 and 13 - about 1,200 clients who need help in such areas as mobility and eating.

Services to about 3,600 people in levels 14 to 17 were eliminated in budget reductions in early 2003, and were not restored.

Some other features of the 2003-2005 budget:

The budget provides a scaled-down replacement for the department's former General Assistance program. This program provided cash assistance to about 2,600 low-income people with disabilities waiting for determination of their Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) claims.
The new program serves about 1,150 clients, focusing on those deemed likely to meet SSI criteria.

Subject to federal approval, the budget provides prescription drug coverage for seniors and people with disabilities with incomes up to 133 percent of the federal poverty level, with some cost sharing by program participants. This will allow many of those formerly enrolled in the department's Medically Needy program to regain some coverage.

Funding for Oregon Project Independence, which provides in-home services for clients who do not qualify for Medicaid, was restored to $7.6 million. Overall, the program is funded at a level that's $6.1 million below that of 2001-03.

Funding continues for residential care facilities and adult foster homes at their 2001-2003 legislatively approved levels. However, the budget allows 2.6 percent cost-of-living increases for assisted living facilities in each year of the biennium.

The budget includes funding for a re-negotiated Staley Agreement, which provides services to people with developmental disabilities.

A tax on nursing facilities, scheduled to be implemented February 1, 2004, will provide additional funding for services to seniors and people with disabilities.

Other-fund revenue generated through tax collection will be used to provide increases in Medicaid nursing facility rates.

As the 2003 legislative session proceeded, advocate groups, service providers and others gave lawmakers comprehensive information about the value of treatment, said Bob Nikkel, administrator of the department's Office of Mental Health and Addiction Services.

"By the end," he said, "legislators had become champions for an integrated system in which mental health and addiction treatment services are an essential piece."

Legislators made significant restorations to mental health services, including community mental health treatment for severely ill children, adolescents and adults who do not have any means to pay.

Partial restorations were made to community mental health crisis services, and to the child and adolescent psychiatric day treatment program. Some Oregon Children's Plan funds were restored for treatment of parents whose alcohol and drug problems place their young children at risk, and for treatment of parents or their young children who are at risk due to mental disorders.

Other major developments during the session included partial restoration of Lottery-funded prevention and treatment of problem gambling, and restoration of $2.7 million for residential alcohol and drug services.

In addition, partial restoration of the General Assistance program and former Medically Needy program will help Oregonians with mental health or addiction problems find adequate housing and access to medications.

Nikkel said that organizations such as the National Alliance for the Mentally Ill were key in raising awareness about mental illness and addiction throughout the session. He also credited county mental health directors, alcohol and drug providers, and other partners and stakeholders.

"For thousands of Oregonians, recovery from mental illness and rehabilitation from addiction is real, and providing appropriate and timely services to them is vital," he said. "Working with our partners, we will deliver services to ensure the best outcomes for children and adults."

Restoration of Health Plan services requires federal approval

The department is seeking federal approval to permit the Oregon Health Plan to partially restore services that were eliminated last spring to balance the state budget.

The changes would affect about 55,000 adults statewide who are covered by the Health Plan's Standard benefit package, which on March 1 eliminated coverage for dental services, medical supplies and outpatient mental health and chemical dependency services.

The Standard package covers people whose incomes are below the federal poverty level but who wouldn't qualify for coverage under conventional federal Medicaid law.

In the 2003-2005 budget, the legislature restored mental health and chemical dependency benefits, medical supplies, and emergency dental services to the Standard benefit package. Coverage was continued for prescription drugs and services such as doctor and emergency room visits.

Hospital services in the Standard benefit package were reduced to about 70 percent of the value of the current hospital benefit. Emergency services and admission for conditions requiring prompt treatment to prevent life-threatening health deterioration will be part of the new hospital benefit package. Oregon hospitals and managed care plans are paying new provider taxes that will offset some Health Plan costs.

The limited dental services package will include extractions and some additional emergency services.

Assuming federal approval is received in time, the revised Standard benefit package would go into effect on Jan. 1, 2004. Approval is required because the federal Medicaid program pays about 60 percent of Health Plan costs.

Lynn Read, state Medicaid director, said lawmakers recognized the importance of mental health and chemical dependency coverage, which they restored.

Lawmakers also broadened eligibility for the Children's Health Insurance Plan (CHIP), permitting children and teens to qualify in households with incomes up to 200 percent of the federal poverty level (up from 185 percent currently). Broadening CHIP eligibility also requires federal approval.

Read said the department already had requested federal approval to move by 30 places the line on the Health Plan's prioritized list of medical conditions and treatments, from line 549 to line 519. Among the treatments that would be eliminated, subject to federal approval, are those for chronic ear infections, carpal tunnel syndrome, urinary incontinence, osteoporosis and osteoarthritis.

As a major expenditure, Health Plan services could be affected if tax increases that the legislature used to balance the budget are referred for a statewide vote and overturned in a February election.